Have we been doing it all wrong? The role of “super-especialists” doctors in COVID-19 pandemic and Medicine 4.0 era.

Gustavo Pampolha Guerreiro MD, Valdano Manuel MD, Lucas Figueredo Cardoso MD

Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP) - São Paulo, Brazil.

Corresponding author: Gustavo Pampolha Guerreiro - Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, Av. Dr Enéas de Carvalho Aguiar, 44 – Pinheiros, Sao Paulo - Brazil.

Email: gustavo_guerreiro@hotmail.com

Telephone: +5511998347107

Conflicts of interest: None declared

Funding: None

Word count: 1014

Keywords: COVID-19; Medicine 4.0; Pandemic.5

Since the beginning of the teaching process in modern medical schools, the evolution of medicine brought up the need for medical education to also evolve. We passed through the ages of the theaters where surgeries and lectures were performed and the teachers were the main source of knowledge until today with technology, simulation-learning, and evidenced-based medicine when information comes from multiple sources so it is important is to filter to achieve reliable conclusions.^1-3

Medicine evolution also allowed us to confirm and refute hypotheses, discover new drugs and technologies, understanding better the pathophysiology, and consequently adequate treatment of many diseases. Thus the knowledge has been increased in all medical areas, and it required doctors to study more specific subjects to better understand its implications. That way, traditionally recognized areas in medicine originated subareas of knowledge capable of generating more hypothesis and developing higher quality evidence.^4,5

As so, the referral of patients to specialized doctors in subareas of medicine became the gold standard of patient care. However, most of the time, one patient needs an approach from different specialized doctors, who - unfortunately - do not interchange their expertise to individualize one’s treatment and therefore do not give the best care to the patients.⁶

Furthermore, globalization has affected medicine and health care systems to a great degree. While in the past centuries it could took almost one year for an infectious disease spread across continents - as seen in the influenza epidemic -, we have recently seen the outbreak of Coronavirus Disease 2019 (COVID-19) escalate to a pandemic within five months hitting over 212 countries.⁴ Suddenly many specialist doctors found themselves in a situation they had not faced for a long time: having to treat patients out of their subarea of expertise. The possibilities of teaching and learning through the modality of webinars brought to these days the urgent need for teamwork and interdisciplinary approach for patient care, taking advantage of multiple areas of knowledge.^7,8

The question is: have we been doing it all wrong when we have become “super-specialists”? We think not! With the exponential increase in the quantity of available information and the speed at which data can be accessed and analyzed, it is impossible to be aware of every new content in all medical areas. The lesson that COVID-19 pandemic brought to us was the urgent need for the interdisciplinary approach to treating better our patients, and not only each individual disease that they present. Even though this concept is not new, in the current era, it became difficult to find teamwork in medicine. The Heart Team (multidisciplinary approach for cardiovascular disease patients) is a great example regarding this issue. Experts have been proposing teamwork as the gold standard to establish a better strategy to treat a complex cardiovascular disease patient, however, the effective Heart Team implantation around the world remains a challenge.^9,10

Telemedicine during the COVID-19 era taught us so much. We must review our traditional approach to medical students, residents, colleagues, and patients in which we became stuck to distance and time obstacles. We must use the technology on our behalf to offer the best treatment and follow-up for patients. We live now in the Medicine 4.0 era.¹² As Darwin a long time ago proved: we must evolve!

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